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Ankara University School of Medicine Department of Thoracic Surgery Ankara

TRANSBRONCHIAL NEEDLE ASPIRATION BIOPSY (TBNAB) AND THE VALUE OF ON-SITE CYTOPATHOLOGICAL EXAMINATION FOR LUNG CANCER AND MEDIASTINAL LYMPHADENOPATY: “85 CASES” Serkan ENÖN, Cabir YÜKSEL , Koray CEYHAN, Ayten KAYI CANGIR, Nezih ÖZDEMİR, Murat AKAL. Ankara University School of Medicine

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Ankara University School of Medicine Department of Thoracic Surgery Ankara

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  1. TRANSBRONCHIAL NEEDLE ASPIRATION BIOPSY (TBNAB) AND THE VALUE OF ON-SITE CYTOPATHOLOGICAL EXAMINATION FOR LUNG CANCER AND MEDIASTINAL LYMPHADENOPATY: “85 CASES”Serkan ENÖN, Cabir YÜKSEL, Koray CEYHAN, Ayten KAYI CANGIR, Nezih ÖZDEMİR, Murat AKAL Ankara University School of Medicine Department of Thoracic SurgeryAnkara

  2. TBNA • 1950 Brouet and Euler: Rigid bronchoscopy • 1978 Wang: Flexible bronchoscopy

  3. TBNAB • Diagnosis and staging of lung cancer • Diagnosis of mediastinal lymphadenopathy • Alternative to mediastinoscopy? • Less invasive • Cost effective • Secure • Diagnostic procedure

  4. TBFNAB is not performed worldwide • In 1990’s it is performed in US %12, • in UK % 27 • Recent years % 54 WHY ? • Difficult technique • Experimentation need • No onsite diagnosis • Low specificity and sensitivity

  5. AIM • Aim of this study is to determine the diagnostic value of TBNAB and on-site cytopathological examination

  6. PATIENTS-METHODS • February 2004 - February 2007 • Ankara University School of Medicine, Department of Thoracic Surgery • TBNAB was performed to 85 cases with lung cancer and mediastinal LAP

  7. PATIENTS-METHODS • Under general anesthesia, laryngeal mask • FOB and 12mm length/19-22G Wang needles, • Accompanying same cytopathologist.

  8. PATIENTS-METHODS • During the operation, sufficiency assignment was done by the cytopathologist through the biopsy materials. • Finding out lymphoid cells or tumor infiltration was accepted as a sufficiency criteria. • Surgical procedures were done in other cases not including these criteria, then.

  9. RESULTS • Male : 57 (%67,1) • Female : 28 (%32,9) • Age(med) : 51,74(14-76)

  10. RESULTS • 47 malign (%55,3) • 38 benign (%44,7)

  11. MALİGN CASES:47 (%) • Adenocarsinoma...................................: 16 %34 • Squamaus cell carsinoma....................: 13 %27,7 • Small cell cancer..................................: 9 %19,2 • Large cell carsinoma...........................: 5 %10,7 • Non small cell carsinoma ..................: 1 %2,1 • Hodgkin disease...................................: 2 %4,2 • Malign peripheral nerve sheat tm...: 1 %2,1

  12. BENIGN CASES: 38 • Granuloma:28 (%73,7) • 18 sarcoidosis • 7 tuberculosis • 2 reactive granuloma(tm or Behçet disease reaktive ) • 1 granulomateous angitis • Reaktive lymphoid hyperplazi:10 (%26,3)

  13. THE RATIO OF DIAGNOSIS • MALIGN: 46/47 (%97,87) • Non-diagnostic : 1 patient -> biopsy LCNEC • BENIGN: 32/38 (%84.21) • Non diagnostic: 6 patients • 3 tbc (2 necrosis, 1 reaktive lymphoid hyperplasia) • 3 reaktive lymphoid hyperplasia)

  14. Difficulty in diagnosis: 7 pts • 4 non-diagnostic (on-site) • 3 reaktive lymphoid hyperplasia • 1 large cell carsinoma • 2 necrosis (on-site) • Tissue diagnosis: tbc • 1 reaktive lymphoid hyperplasia (on-site) • Tissue diagnosis: tbc

  15. TOTAL • Correct Diagnosis 78/85 ( %91.76)

  16. EVALUATION OF LYMPH NODES • Lymph node size :22,75 mm (7-70 mm) • Lymph n ode biopsy n: 126 • Correct diagnosis n: 104 • Diagnostic ratio: 104/126 (%82.53)

  17. CORRECT DIAGNOSIS ACCORDING TO LYMPH NODES • Lymph node no 2 : 14/17 (%82,4) • Lymph node no 3 : 7/12 (%58,3) • Lymph node no 4 : 10/15 (%66,7) • Lymph node no 7 : 66/74 (%89,2) • Lymph node no 10 : 2/2 (%100) • Lymph node no 11 : 5/6 (%83,3)

  18. How should be correct diagnosis of TBNAB increased? • Experience • Min 2-3 years and 50 TBNAB • Size of LAP • > 20 mm diagnostic ratio %80 • Number of procedure • At least 5 • Localisation of LAP • Subkarinal LAP

  19. How should be the sensitivity of TBNAB increased? • Diamater of the needle • 18-19 g : Able to co-investigation of cytology and histology • Radiological support • Endobronchial USG, BT-fluroscopy , Endoscopic USG • Accompaniment of cytopatholog (on-site cytopathologic examination)

  20. On-site cytopathologic examination • Decreases inadequate results • Prevents unncessary manipulations therefore minimizes the complications • Increases the sensivity significantly (%50  %80)

  21. CONCLUSION • TBNAB is an efficient and reliable method for diagnosing and/or staging the lung cancers and mediastinal LAP

  22. CONCLUSION • The ability and experience of bronchoscopist and on-site cytopathologic examination are the most important factors for the success of procedure

  23. CONCLUSION • When these factors come together, diagnostic accuracy increases over 90% and the patients can be preserved from invasive surgical procedures such as mediastinoscopy or thoracotomy.

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